Falls are the important causes of morbidity and mortality in older adults. Although clinical staff have paid attention to the management of falls, adherence to fall interventions is not satisfactory, resulting in the high incidence of fall. Understanding the older adults' own perception of fall risk from their perspective may be the key to fall prevention, especially active fall prevention. In this paper, we reviewed the concept of fall risk perception, behavioral consequences and influencing factors of fall risk perception in older adults from the perspective of "the first person responsible for health", and found that there are fewer studies on fall risk perception in older adults at home and abroad, the conceptual connotation still needs to be further explored. Subjective perceptions of fall risk in older adults can lead to different patterns of fall risk coping behaviors that influence fall risk. The influencing factors of fall risk perception mainly focus on the emotional psychology, physiological conditions, social culture, and physical environment, with the influencing process through subjective cognition. Empirical studies can be used to further validate the psychological cognitive mechanisms of fall risk perception in conjunction with the risk perception formation process in the future, in order to provide empirical evidence for proactive fall prevention.

Falls among older adults will cause a heavy burden on society and families. The development of effective falls prevention intervention policies for community-dwelling older adults is an important initiative to address this global public health problem.

To analyze and compare the content composition, key initiatives and implementation strategies of current falls prevention intervention policies for community-dwelling older adults in different countries from the perspective of policy tools.

Six countries in Asia, North America, and Europe, including Japan, Singapore, Thailand, the United States, Germany, and Russia, were selected as sample countries according to the degree of population aging and economic income level. Refer to the websites of relevant government departments such as the Ministry of Health, the Center for Disease Control and Prevention and directly affiliated institutions, as well as websites of nongovernmental organizations, such as Prevention of Falls Network Europe, National Council On Aging, U.S., Association of Fall Prevention, Japan, and National Association of Statutory Health Insurance Funds, Germany, the national policy documents of prevention interventions for community-dwelling older adults from January 2010 to June 2022 were searched by using "older adults" "fall/drop/accidental injuries" "prevention" as keywords. The text analysis was performed from the dimensions of policy tools such as demand-side type, supply-side type and environmental-side type, and injury prevention strategies such as education prevention strategies and evaluation strategies.

Among the 24 policy documents, there were 212 coded targets in the dimension of policy tools, with environmental-side type, supply-side type and demand-side type policy tools accounting for 45.3% (96/212), 40.6% (86/212) and 14.1% (30/212), respectively. Among high-income countries, the public service tools under supply-side type policy tools were mostly applied in the United States and Germany, accounting for 40.5% (17/42) and 13.8% (8/58) ; the infrastructure construction tools under supply-side type policy tools were focused in Singapore〔24.1% (7/29) 〕. Among low and middle income countries, the environmental-side type policy tools were mostly applied in Russia and Thailand, accounting for 51.3% (20/39) and 55.6% (10/18), respectively. Public service was mostly applied among the supply-side type policy tools, accounting for 17.5% (37/212) ; technical standard was mostly applied among the environmental-side type policy tools, accounting for 10.8% (23/212) ; medicare payment was mostly applied among the demand-side type policy tools, accounting for 4.7% (10/212). In addition, there were 105 coded targets in the dimension of injury prevention strategies, with the education prevention strategies accounting for the highest proportion of 31.4% (33/105), the engineering strategy accounting for the lowest proportion of 5.7% (6/105). High-income countries are at the stage of multi-sectoral collaborative policy implementation, low and middle income countries are at the stage of policy implementation by the Ministry of Health stage.

Six countries focus on public service and infrastructure development under supply-side type policy tools; the application of demand-side type policy tools can be summarized as intervention services managed by medical insurance, intervention projects supported by financial funds, service purchases attracted by price subsidies, planning, organization, advocacy, and standard setting of environmental-side type policy tools. In combination with the priorities and specific measures of the six countries, it is suggested to learn from advanced experience in improving public services, strengthening evidence-based projects, standardizing technical standards, supporting financial incentives, expanding medical insurance programs, and providing price subsidies, thus further optimizing falls prevention intervention policies for community-dwelling older adults.

Older adults with apathy have a high risk of falls and are prone to repeated falls . Few interventions could achieve satisfactory effects on improving apathy, although improved apathy is associated with a reduced risk of falls. Improving frailty may be a new method for reducing the risk of falls in older adults with apathy.

To investigate the mediating effect of frailty between apathy and risk of falls in older adults in the community, so as to provide a new idea for reducing the fall risk in this group.

A total of 212 community-dwelling older adults were selected to attend a survey by convenience sampling from November 2021 to March 2022, including 128 from Dongshan Community Health Center, Nanjing, and 84 from Qinghu Town, Donghai County, Lianyungang. A self-developed Demographic Information Questionnaire, the Fried Frailty Phenotype (FFP) , Geriatric Depression Scale (GDS-3) , Stopping Elderly Accidents, Deaths & Injuries Tool Kit (STEADI) were used to collect demographics, frailty prevalence, apathy prevalence, and risk of falls, respectively. The intermediary role of frailty in apathy and fall risk was analyzed.

One hundred and ninety-two cases (90.6%) who responded effectively to the survey were included for analysis. The average total STEADI score, average total GDS-3 score, and FFP score of the respondents were 2.0 (0, 4.0) , (1.6±0.9) , and 0 (0, 2.0) , respectively. Fifty-six (29.2%) and other 136 cases (70.8%) were assessed with and without fall risk, respectively. Spearman rank correlation analysis showed that apathy was positively correlated with frailty and fall risk, (r_s=0.303, 0.388, P<0.05) , and frailty was positively correlated with fall risk (r_s=0.424, P<0.05) . The analysis using intermediary Model 4 showed that apathy had a significant positive effect on fall risk (B=1.011, t=5.207, P<0.05) ; apathy significantly positively influenced frailty (B=0.324, t=3.800, P<0.05) ; frailty had a significant positive effect on fall risk (B=0.679, t=4.173, P<0.05) . Bootstrap test showed that the effect size of frailty in the path of "apathy→frailty→fall risk" was 0.22 〔95%CI (0.08, 0.40) 〕, indicating that frailty played a mediational role between apathy and risk of falls. Apathy could directly affect the fall risk, and could indirectly affect the fall risk through frailty. The total effect was 1.01, in which the size of direct effect was 0.79, the size of mediator effect was 0.22 (accounting for 21.78%) .

Frailty may be a mediator between apathy and fall risk in older adults in the community, and improving frailty is an important way to reduce risk of falling.

With the aging of the population, it is essential to implement fall prevention programs for the elderly. Although China has carried out fall prevention programs sporadically, among which comprehensive fall prevention programs centered on exercise intervention are rare, and there have been no investigations about the willingness of elderly people at high risk of falls in the community to participate in comprehensive fall prevention programs.

To examine the intention of community-living elderly residents at high risk of falls to participate in comprehensive fall-prevention programs, and associated factors, providing a theoretical basis for the implementation of such programs.

By economic level and geographical location, we selected three communities from Shanghai as research settings, namely, Tangqiao Community in Pudong New Area (central urban area) , Zhaoxiang Community in Qingpu District (outer suburb) and Gangyan Community in Chongming County (outer suburb) . Elderly people aged 65 and above who participated in physical examinations in the three communities from 2018 to 2019 were invited to attend a survey using a questionnaire consisting of demographics, FROP-Com Screen, MFROP-Com Tool, self-designed fall risk questionnaire, Patient Health Questionnaire-9 (PHQ-9) , and Generalized Anxiety Disorder scale (GAD-7) . Individuals with the FROP-Com Screen scale score >3 points were identified with risk of falls, among whom those with total score of MFROP-Com Tool≥11.5 points (high risk of falls) were included finally.

In total, 318 cases were detected with high risk of falls, among whom 62 (19.5%) thought falls were unpreventable. Slippery floor〔73 respondents (23.0%) 〕, inattention〔64 respondents (20.1%) 〕and physical discomfort〔64 respondents (20.1%) 〕were reported to be the three leading causes of falls. Two hundred and fourteen (67.3%) were willing to participate in fall prevention programs. The level of intention to participate in fall prevention programs differed significantly in the participants according to living setting, educational level, use of a walker, self-assessed sleep quality, number of chronic diseases, foot disease prevalence, exercise habits, history of falls in the past year, and cognition of whether falls can be prevented (P<0.05) . Binary Logistic regression analysis showed that living in urban area〔OR (95%CI) =7.828 (2.898, 21.149) 〕, having an exercise habit〔OR (95%CI) =3.474 (1.703, 7.087) 〕, previous history of falls〔OR (95%CI) =2.806 (1.364, 5.773) 〕, and having an idea of falls are preventable〔OR (95%CI) =4.124 (1.749, 9.726) 〕 were associated with higher level of intention to participate in an fall prevention program (P<0.05) .

In general, the community-living elderly residents with high risk of falls had limited understanding of fall prevention, but most of them were willing to participate in fall prevention programs. To promote the implementation of comprehensive fall prevention programs, it is necessary to improve their awareness of fall prevention and enhance their willingness to participate.

There are few studies on the relationship between sleep time and falls at present, and the research results are inconsistent.

To explore the relationship between sleeping time and falls in middle-aged and elderly residents in China, and to provide reference for preventing falls in this population.

The study based on the data from China Health and Retirement Longitudinal Survey (CHARLS) data in 2015. 18 181 subjects aged ≥45 years with complete key data were included. Collect the indicators of the middle-aged and old people in the past two years, such as falls and medical treatment, sleep time, demographic characteristics, behavior and lifestyle, health status, self-life satisfaction and self-rated health. The subjects were divided into 5 groups according to the sleep time per night: <5 h (2 945 cases) , 5-<6 h (2 755 cases) , 6-<7 h (reference group, 3 824 cases) , 7 to <8 hours (3 257 cases) and ≥8 hours (5 400 cases) . Logistic regression model was used to adjust different variables to gradually evaluate the relationship between sleep time and the occurrence of falls and medical treatment for falls in the past two years.

The average sleeping time of middle-aged and elderly people was (6.4±1.9) hours, the incidence of falls in the past two years was 17.01% (3 092/18 181) , and the rate of medical treatment for falls was 6.95% (1 264/18 181) . The incidence of falls in subjects with sleep time <5 h, 5-<6 h, 6-<7 h, 7-<8 h and≥8 h were 25.26% (744/2 945) , 19.82% (546/2 755) , 15.51% (593/3 824) , 14.03% (457/3 257) , 13.93% (752/5 400) , the incidence of falling to hospital was 10.97% (323/2 945) , 8.09% (223/2 755) , 6.04% (231/3 824) , 5.43% (177/3 257) and 5.74% (310/5 400) , which were significant differences demonstrated by the trend chi-square test, and the difference was statistically significant (P<0.05) . Compared with 6-<7 hours after adjusting factors such as age, gender, those with sleeping time ≥8 hours had a significantly lower risk of falling〔OR (95%CI) =0.88 (0.78, 0.99) 〕, and those with sleeping time <5 h and 5-<6 h had a significantly higher risk of falling〔OR (95%CI) _{<5 h}=1.31 (1.16, 1.49) , OR (95%CI) _{5-<6 h}=1.14 (1.00, 1.30) 〕. The middle-aged and old people who slept less than 5 hours per night had a higher risk of falling and seeking medical treatment〔OR (95%CI) =1.30 (1.08, 1.56) 〕.

The incidence of falls in middle-aged and elderly people in China is relatively high, sleep time <6 hours per night will increase the risk of falls, and sleeping≥8 hours may reduce the risk of falls. Adjusting sleeping time of middle-aged and elderly people and strengthening lifestyle intervention can effectively reduce the incidence of falls in the middle-aged and elderly people.

Gait speed and grip strength are simple markers of physical capability, which are associated with adverse outcomes in the elderly. However, there are few studies on the prediction of adverse outcomes in this population by the combination of the two markers.

To investigate the associations of gait speed and grip strength with adverse outcomes in geriatric inpatients.

A cohort design was used in this study. From August 2015 to December 2018, eligible geriatric inpatients aged≥65 years were recruited from Department of Geriatrics, Fuxing Hospital, Capital Medical University. We measured the gait speed and grip strength with 6-meter walking test and dynamometer, respectively. By the gait speed, the patients were divided into tertiles (T1 group: ≤ 0.6 m/s, T2 group: >0.6-0.8 m/s, T3 group: >0.8 m/s). By the grip strength, they were divided into L1, L2 and L3 tertiles (L1 group: ≤ 21.6 kg for males, ≤ 14.6 kg for females; L2 group: > 21.6 kg but ≤ 28.2 kg for males, >14.6 kg but ≤ 19.4 kg for females; L3 group: >28.2 kg for males, >19.4 kg for females). Follow-up was conducted by telephone once every three months within one year after discharge and once half a year after this until December 31, 2019. All-cause mortality and falls were recorded. Survival curves were constructed by the Kaplan-Meier method. Cox regression analysis was used to investigate the association of gait speed, grip strength, or their combination with all-cause mortality and falls. ROC curves for comparing the ability of the two makers or their combination on predicting all-cause mortality and falls.

Among the 685 patients, 29 (4.2%) were lost to follow-up, and the other 656 cases who finished the follow-up with complete data were included for analysis. During the follow-up period, 130 patients (19.8%) died from all causes and 147 patients (22.4%) experienced falls. There were 222, 225 and 209 patients in the low, moderate and high tertiles of gait speed (T1, T2 and T3 groups), and 215, 229 and 212 patients in the low, moderate and high tertiles of grip strength (L1, L2 and L3 groups), respectively. Log-rank test showed that the cumulative survival curves of all-cause mortality and falls differed significantly among T1, T2 and T3 groups (P<0.01). The same results were obtained in L1, L2 and L3 groups (P≤0.01). Cox regression analysis with adjustment for potential confounders showed that compared to patients in high tertiles of both gait speed and grip strength, the risk of all-cause mortality significantly increased in those both in low gait speed and low or moderate tertiles grip strength〔HR=3.29, 95%CI (1.13, 9.55) ; HR=3.09, 95%CI (1.08, 8.85) ; P<0.05〕, and the risk of fall significantly increased in those in low tertiles of both gait speed and grip strength 〔HR=1.92, 95%CI (1.13, 4.27), P<0.05〕. The prediction probability of the joint diagnostic model of gait speed and grip strength was estimated by Logistic regression analysis, and the AUC of the combination of them for predicting all-cause mortality and falls was 0.756 〔95%CI (0.710, 0.801) 〕, and 0.700〔95%CI (0.659, 0.741) 〕, respectively.

In geriatric inpatients, the combination of gait speed and grip strength had higher predictive value for all-cause mortality and falls, which is helpful to optimize the health management.

The Self-rated Fall Risk Questionnaire (FRQ) developed by the US CDC is one of the few questionnaires applied for fall risk self-assessment in community-dwelling older adults, which is thought to be simple and highly applicable. The Modified Falls Efficacy Scale (MFES) is also widely used in the fall risk assessment in older adults. Thus the comparison between the Self-rated FRQ and MFES in identifying fall risk in older adults would be meaningful.

To explore the applicability of the Chinese version of Self-rated FRQ (FRQ-C) in assessing the fall risks in community-dwelling older Chinese adults by comparing it with the Chinese version of MFES (MFES-C) .

A total of 203 seniors above 65 who received physical examination services, treatment services, or vaccination services from the community health center were selected by use of convenience sampling and invited to attend a survey for understanding their demographics, and fall risk rated by the MFES-C and the Self-rated FRQ-C. ROC analysis was conducted to assess the performance (sensitivity, specificity, positive and negative predictive values) of the Self-rated FRQ-C and MFES-C in the prediction of having at least one or two falls in the past year.

Fifty-eight (28.6%) of them fell once or more in the past year. The mean score of the Self-rated FRQ-C for the fall group was higher than that of the non-fall group with a statistically significant difference (P<0.001) . But no significant difference in the mean score of the MFES-C was found between the two groups (P>0.05) . Those with high fall risk assessed by the Self-rated FRQ-C (≥4 points) had higher prevalence of fall (P<0.05) . However, no higher prevalence of fall was found in those with high fall risk assessed by the MFES-C (≤112 points) (P>0.05) . The AUC values in identifying having one or more falls in the past year for the Self-rated FRQ-C and MFES-C were 0.74〔95%CI (0.68, 0.81) 〕 and 0.59〔95%CI (0.50, 0.68) 〕. When identifying having two or more falls in the past year, the AUC value of the Self-rated FRQ-C increased to 0.80〔95%CI (0.70, 0.90) 〕, and that of the MFES-C increased to 0.65〔95%CI (0.52, 0.78) 〕. The sensitivity and specificity of the Self-rated FRQ-C with a threshold of 4 points were 81.0% and 51.7%, respectively, and those of the MFES-C with a threshold of 112 points were 53.5% and 60.0%, respectively.

Compared with the MFES-C, the Self-rated FRQ-C may have higher sensitivity in identifying fall risk in older adults with higher operability and applicability in community settings.

Hemiplegia patients in the convalescent period of stroke generally have gait, balance dysfunction and the risk of falling, which seriously affects their daily living ability and prognosis. Traditional exercise therapy such as Tai Chi can play its unique advantages as an intervention, but there are different practice routines and insufficient evidence of evidence-based medicine, which limit its clinical application.

To observe the effect of modified Tai Chi on the disorder of gait and balance and fall efficacy in patients with hemiparesis in convalescent stage of stroke.

A total of 68 patients with hemiplegia in the convalescent stage of stroke who were admitted to the Second Affiliated Hospital of Heilongjiang University of Chinese Medicine from June 2020 to July 2021 were selected and divided into an observation group (n=34) and a control group (n=34) by random number table method. On the basis of routine rehabilitation treatmentonboth groups, the control group received motor relearning program (MRP) , whereas the observation group received modified Tai Chi intervention, once a day, 30 min a time, and 5 days a week, for 8 weeks. The two groups were assessed before and after the intervention using Fugl-Meyer assessment of lower extremity (LE-FMA) , 6-min walking test (6MWT) , Berg Balance Scale (BBS) , timed up and go test (TUGT) , modified Barthel index (MBI) , step length, frequency and speed, and modified fall efficacy scale (MFES) .

One case dropped out in the observation group, and a total of 33 cases were included, while there was no dropout in the control group, and a total of 34 cases were included. There was no significant difference between the two groups on the results of LE-FMA, 6MWT, BBS, TUGT, MBI, step length, frequency and speed, and MFES before the treatment (P>0.05) . No significant difference was found in TUGT time and step length between the two groups after the treatment (P>0.05) . However, after the treatment, LE-FMA, BBS, MBI, MFES scores, step frequency and speed in the observation group were higher than those in the control group, and 6MWT walking distance was longer (P<0.05) . Furthermore, LE-FMA, BBS, MBI, MFES scores, step frequency and speed after treatment were higher than those before treatment, 6MWT walking distance was longer and TUGT time was shorter than that before treatment (P<0.05) .

Modified Tai Chi can effectively improve gait and balance disorder and fall efficacy in patients with hemiparesis in the convalescent stage of stroke.